Wells 11-29-07 Electronic Fetal Monitoring

Front 1

Describe normal fetal heart rate and variability.
Describe accelerations and their significance.
Describe the types of decelerations, significance, and interventions.
Identify FHT patterns

Back 1

Objectives

Front 2

Fetal heart rate is controlled by the _________ nervous system.

a) symp
b) parasymp
c) symp and parasymp
d) neither

Back 2

sympathetic and parasympathetic

Front 3

Baseline heart rate at term is ____ bpm.

Back 3

120-160

Front 4

Bradycardia = FHT’s less than 120 for ___ sec or more

Back 4

15

Front 5

Tachycardia = FHT’s greater than 160. _____ is mild tachycardia, ____ or higher is severe tachycardia.

Back 5

161-180

181

Front 6

_________ = change in beat to beat rate

Back 6

Variability

Front 7

Short term variability = changes from 1 R wave to next R wave. Need fetal ______ electrode for this.

Back 7

scalp

Front 8

Long term variability = changes that occur over how long?

Back 8

1 minute.

Front 9

Variability is sensitive to fetal __________ (acid-base) status.

Back 9

biochemical

Front 10

If baby is acidotic, describe the baby's variability.

Back 10

flat. (low variability)

Front 11

______ variability suggests aduquate oxygenation.

Back 11

Good

Front 12

_______ variability is associated with fetal hypoxia, acidemia, drugs, sleep, prematurity, CNS or cardiac abnormalities

Back 12

Decreased

Front 13

Sinusoidal pattern
Is associated with severe fetal _______

Back 13

anemia

Front 14

Sinusoidal pattern
Is associated with severe fetal anemia.
Stable baseline @ 120-160 bpm
Amplitude of ____ bpm
Frequency of _____ cycles / min

Back 14

A = 5-15 bpm

2-5 = cy/min

Front 15

Describe acceleration in the setting of a sinusoidal pattern

Back 15

Absence of acceleration

Front 16

Describe short term variability in the setting of a sinusoidal pattern

Back 16

Fixed or flat short term variability

Front 17

Accelerations = increase in FHR of 15 beats above baseline for how long?

Back 17

15 sec

Front 18

Presence of what Demonstrates a mature neurocardiac tract.

Back 18

Accelerations

Accelerations are reassuring of fetal well- being.

Front 19

During labor the uterus contracts and constricts vessels to placenta, but a Placenta that is adequate can maintain oxygen/CO2 exchange. Baby gets squeezed and FHT’s demonstrate accels, with return to ______.

Back 19

baseline

Front 20

______ = slowing of FHR.

Back 20

Decelerations

Front 21

Three types of decels :
1. Early – associated with what?
2. Variable – associated with what?
3. Late – associated with what?

Back 21

1. Early – associated with head compression.
2. Variable – associated with cord compression.
3. Late – associated with uteroplacental insufficiency.

Front 22

Early decelerations are a Decrease in FHR with contractions 20-30 beats below baseline.
Due to head compression that stimulates the _____ nerve from dural stimulation.

Back 22

vagal

Front 23

Early deceleration begins with U/C, nadir at peak of contraction, and return to baseline at end of contraction. (Mirrors contraction).

Is treatment necessary?

Back 23

no

Front 24

Why check the patient with early deceleration?

Back 24

the head is probably descending

Front 25

Variable decelerations
Sharp decrease in FHT’s due vagal response to what?

Occur anytime as a rapid fall and rapid return of FHT’s.

Back 25

cord occlusions

Front 26

Significant variable decels decrease to less than 70 bpm and last more than ___ sec.

Back 26

60

Front 27

If persistent deep variables will cause fetal _____.

Back 27

hypoxia

Front 28

If pt has persistant deep variables, should you check the pt?

Back 28

yes. May try to change maternal position, amnioinfusion.


Not necessary for "every now and then" variables.

Front 29

____ decelerations.
Symmetrical decrease in FHT’s beginning at peak or after peak of contraction and returns to baseline after contraction over. Descent and return are smooth.

Back 29

Late

Front 30

Late decelerations are associated with uteroplacental insufficiency from uterine ______ or decreased placental ________.

Back 30

uterine perfusion or decreased placental function.

Front 31

Some causes of uteroplacental insufficiency are post dates, placental abruption, ____ hypertension, _____ DM, ______ anemia, _______ sepsis, hyperstimulation, hypertonia

Back 31

maternal

Front 32

Treatment for late decels

Back 32

Check the patient.
Maternal oxygen.
Turn mother to left side.
IV fluid bolus.
Stop pitocin if indicated.
Amnioinfusion.

Front 33

If unborn baby's BPM drops to 70 for 60 secs, it is hypoxic. How long can it be hypoxic and turn out ok?

Back 33

30 minutes

Front 34

acidotic baby causes flat variability. Also what meds?

Back 34

narcotics